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Meet Rachel and Nicola – the health board’s Macmillan GP Facilitators

macmillangp.jpg

Palliative care patients to benefit from new GP role in Cwm Taf

PATIENTS receiving palliative care will benefit from the services provided by two Macmillan GP facilitators appointed by Cwm Taf Health Board.

They will work closely with GPs and district nurses to ensure better communication between hospital and community services for patients and with the out of hours service.

macmillangp.jpgDr Rachel Lee and Dr Nicola Lewis (pictured), who are both GPs in the Cwm Taf area, have been appointed as the health board’s Macmillan GP facilitators.

Macmillan GP facilitators are key members of the palliative care team and are responsible for enhancing primary healthcare team’s knowledge and skills about cancer and non-cancer palliative care patients, This includes looking after patients at the end of their lives and also supporting the growing number of people who are surviving cancer thanks to improved diagnosis and treatments.

The role also includes raising the profile of palliative care, advance care planning and cancer survivorship and to developing general practitioners with an interest in palliative care.

Following their appointment in September, they have produced information packs for out of hours GPs, which include all the relevant forms needed for end of life care and provides guidance for GPs.

All GP practices have palliative care registers that identify patients requiring supportive, palliative care.

An end of life pathway has been created for GPs to assist with the care of their patients on the palliative care register. This contains all the relevant forms needed for end of life care. The aim of the pathway is to support GPs in enabling patients to die at home if this is their wish.

Dr Nicola Lewis said: “This role has enabled us to work with many different healthcare professionals allowing us to have a positive impact on a number of different aspects of a palliative care patient’s journey. This has included developing resources and guidance to help GPs to deliver high quality care to patients in their last year of life.”

And Dr Rachel Lee, said: “This has been a very rewarding role, and thanks to the support provided both by Macmillan and the health board we have been able to create strong links with primary and secondary care.

“Our goal is to improve the quality of care provided for patients with cancer and for all patients who are in the last year of their life.”

The pair have also been working with Martin Davies, chief pharmacist at Ysbyty Cwm Rhondda to develop the Just in Case boxes.

macmillangp2.jpgThese are sealed boxes, which contain standardised injectable medication suitable for common symptoms, such as pain, breathlessness and agitation, which can arise in patients nearing the end of their lives.

The boxes contain sufficient medication for initial symptom control, and possibly for a syringe driver to be started if appropriate.

The boxes are kept in a patient’s home and are available if they suddenly deteriorate out of hours; they help to avoid lengthy delays in obtaining essential medication outside ordinary working hours.

Martin said: “They improve the access to palliative care medicines and support the provision of care at patient’s homes.

“All GP practices in the Rhondda are now able to prescribe Just in Case boxes. Stage one implementation has gone well and we currently have four patients using the scheme.

“Stage two will take place early in 2014 when the rest of the health board will be included and all patients in the Cwm Taf area will have access to the scheme.”

A website - wIPADS - has been developed by Dr Ian Back, one of Cwm Taf Health Board’s consultants in palliative medicine. This website can be found on www.pallcareinfo.co.uk, the national website for palliative care. Penny Coyle, a Macmillan GP facilitator in Aneurin Bevan Health Board has helped to raise awareness of this site to all professionals.

Dr Back said: “The health board’s strategy group has developed a working document of our aims and goals that is completely aligned to the delivery plan for end of life care by the Welsh Government.

“There is widespread recognition in healthcare that advance care planning is something that we ought to be promoting and encouraging.

“The development of the website is a positive step forward and also the role of the GP facilitator will help to address these issues.

“Rachel and Nicola are two great individuals and Macmillan has been really impressed with what has been achieved by the health board in a short space of time.”

Susan Morris, general manager for Macmillan Cancer Support in Wales, said: “Macmillan is really pleased to have worked with Cwm Taf Local Health Board to fund two Macmillan GP facilitators within the health board.

“Their roles will help GPs and practice nurses to support people affected by cancer, including patients who need end of life care, and help to highlight their needs.

“Rachel and Nicola are two of more than 250 Macmillan professionals working in Wales to support people affected by cancer and we can only fund roles like these thanks to the public’s support.”

A pilot for advance care planning (ACP) started in September in five local nursing homes and will run for four months.

The nursing homes have been provided with two forms which record a patient’s wishes and thoughts for the future. The decisions recorded on these forms are not legally binding but should inform any clinical decisions made on behalf of the patient.

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